Portosystemic shunt embolization in overt hepatic encephalopathy

Research output: Chapter in Book/Report/Conference proceedingChapter


Hepatic encephalopathy develops in up to 50% of cirrhotic patients and up to 80% have precipitating factors. Medical therapy options are mainly limited to nonabsorbable disaccharides and nonabsorbable antibiotics. The majority of patients who recover from an episode of overt hepatic encephalopathy require maintenance medications. However, a small fraction of patients develop recurrent or persistent HE despite optimal medication use. Moreover, this group of patients usually does not have identifiable precipitating factors. In these challenging cases, clinicians should search for a large portosystemic shunt with contrast-enhanced computed topography or magnetic resonance imaging. Patients with preserved liver function with low Model for End-Stage Liver Disease (MELD) score (arbitrarily defined as ≤15) should be considered for shunt embolization. Previous case series have shown improvement of hepatic encephalopathy in 59% to 90% of patients.

Original languageEnglish (US)
Title of host publicationThe Critically Ill Cirrhotic Patient
Subtitle of host publicationEvaluation and Management
PublisherSpringer International Publishing
Number of pages8
ISBN (Electronic)9783030244903
ISBN (Print)9783030244897
StatePublished - Jan 1 2019
Externally publishedYes


  • Embolization
  • Persistent hepatic encephalopathy
  • Portosystemic shunt
  • Recurrent hepatic encephalopathy
  • Refractory hepatic encephalopathy
  • Shunt
  • Splenorenal shunt
  • Spontaneous portosystemic shunts

ASJC Scopus subject areas

  • General Medicine


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